From: Jeni on
On 19 Jan, 11:09, "Welches" <debbie.welc...(a)SPAMntlworldPLEASE.com>
wrote:
> "Anne Rogers" <nos...(a)nospam.com> wrote in message
>
> news:BfednXtmxaIotwzanZ2dnUVZ_jidnZ2d(a)comcast.com...
>
> > good read! I really like seeing how your mind works, I know you don't
> > represent all doctors, but it does help get a perspective on what they are
> > trained in and what they see.
>
> > I was interested in what you said about birth plans, though I was on the
> > delivery unit longer before the birth of my 2nd than you were, it was
> > pretty dramatic and fast paced when I arrived, as well as being in
> > transition, some of both mine and babies obs weren't great, but despite
> > all that someone had managed to open the notes to the birth plan, which
> > was just various boxes being ticked on the page in the hand held notes and
> > have a discussion about it, though I wonder if they did that after the
> > debate about ARM had been had and they figured I was not going to do what
> > their policies said.
>
> > I'm not clear on whether the format of hand held notes is the same across
> > the NHS,
>
> It's not the same across the health boards. When I moved (at 37 weeks) with
> #1 it caused some confusion at my new place as they didn't know where to
> find some of the info, although it was all there.
> Debbie

From the posts on a birth board I use there seems to be quite a wild
difference of use of birth plans. Some women have not even been asked
about their plan. When one asked her mw she was told to download some
information from the internet. I know when I was in labour they looked
at my plan, and my current mw was very interested as I'm planning a
hb. It was useful to know some of the protocol that related to my
choices and medical history, so in that sense it's been worth doing
for a start. And even if they don't get a chance to look at it it's
good to do to at least understand what choices you might need to make
in hospital at critical times when you might not have the time to
consider them in depth. Also I'm going to make sure Dh reads and
understands it, as I did last time - as he's going to be my birth
partner and more importantly my advocate should I need one.

Jeni
From: Sarah Vaughan on
Anne Rogers wrote:
[...]
> A while back I saw an article from an older, respected midwife about
> long, natural 3rd stages, she strongly felt that midwives have lost the
> skill of spotting signs that indicate fairly early on that the placenta
> is ready to be expelled and that by not being aware and ready for that,
> some mothers are having long 3rd stages that may become troublesome and
> fear of this is making others choose syntometrine. I think the time she
> thought was usually for the signs was 10minutes, which is very short
> compared to what younger midwives are saying they normally observe in
> natural 3rd stages. Unfortunately I can't locate the article, but I've
> asked on the list it was posted on to see if anyone else can remember
> enough specifics for a successful search, I thought you'd probably be
> interested to see it.

I'm a little confused (sorry to be dense) - was she saying that if those
signs were spotted then something could be done to make the third stage
shorter?

Format of hand-held notes isn't constant, as Debbie said, but I'd been
with the same unit all the way through so I did have the notes that they
always used - they would have known where to find the birth plan.
Although, come to think of it, I can't remember whether or not the birth
plan covered delayed cord clamping (mine was also a tick-box thing, and
I honestly didn't pay it that much attention when the midwife went
through it). Regardless of whether they had time to read it, there was
no reason for them to rush in and clamp the cord without checking given
that they did know that I wasn't having the Syntometrine. Delayed cord
clamping is now recommended practice anyway. I think that was just a
case of someone automatically doing things the way they'd always been
done. I'm a little miffed about it, but what the hell - mistakes
happen, hopefully they'll have learned that it's worth taking the time
to ask next time, and, as far as I can remember, much of the evidence on
delayed clamping is based on premature babies rather than healthy
full-term babies anyway. I'll just hope that it doesn't affect her!

Glad you liked the birth story!


All the best,

Sarah
--
http://www.goodenoughmummy.typepad.com

"That which can be destroyed by the truth, should be" - P. C. Hodgell

From: Sue on
"Sarah Vaughan" <nannyogg(a)samael.demon.co.uk> wrote in message
>Delayed cord clamping is now recommended practice anyway.
>I'll just hope that it doesn't affect her!

I'm sure she will be fine just like the millions of other babies that the
cord is clamped soon after birth.
--
Sue (mom to three girls)


From: Anne Rogers on

> I'm a little confused (sorry to be dense) - was she saying that if those
> signs were spotted then something could be done to make the third stage
> shorter?

Absolutely, someone found the article for me, it's by Sara McAleese, I
forget her exact credentials, but she's definitely someone respected
within midwifery in the UK and this description was greeted with a big
me too from Mary Cronk. I've copied it below my signature. She explains
that the placenta detaches early on and that a long 3rd stage isn't
usually a placenta that hasn't detached, but one that gets stuck behind
a closing cervix, so the optimal time for the mother to put some work
into delivering it is after detachment but whilst the cervix is still
fully open so gravity can do it's job. Of course if something didn't go
quite as usual and it hadn't detached then it wouldn't have changed
anything.

> I'm a little miffed about it, but what the hell - mistakes
> happen, hopefully they'll have learned that it's worth taking the time
> to ask next time, and, as far as I can remember, much of the evidence on
> delayed clamping is based on premature babies rather than healthy
> full-term babies anyway. I'll just hope that it doesn't affect her!

I think when you look through a range of all the different bits of
research, the only time it doesn't turn out to be a benefit is when the
mother is under a general anaesthetic, but the benefits are much more
marked for babies who are compromised in some way and who don't usually
get a chance to have delayed clamping because equipment isn't set up and
staff aren't trained to do resus with it intact, which is mostly
possible but the techniques are spreading slowly.

Cheers
Anne

Article by Sara McAleese on third stage

But...when you are trying to present physiological third stage in a
positive
light to a clientele whose main concern is how long it will take, it's a
reasonable bit of knowledge to share. I was much influenced by a long
discussion about third stages on sagesfemmes a long time ago. I believe
much of what we understand to be true about phys third stage in this
country
to be uneducated hearsay. In most normal cases, a placenta will detach
from
the wall of the uterus within ten minutes (whether you give an oxytocic
or
not.) Ultrasound studies show this. Sitting around for a couple of hours
waiting for the thing to fall out after it has separated is dull, and
can be
dangerous.
What almost always happens, if you watch carefully and disregard the
things
you think you know about third stage, is this. The baby is born and the
cord pulsates forcefully. The mother greets the baby and gives him or
her
her full attention. Within three to five minutes she will have a
contraction and will usually look up and go 'ooh.' Within five to ten
minutes she will have another, nasty contraction and go 'ow,' and
whatever
she is doing she'll normally shift around uncomfortably. This is because
the placenta has hit her cervix. If you feel the cord, then, it may be
pulsating, but the pulsation will be weak and thready. If she is in, or
gets in an upright position, the placenta will normally plop out. Well
within fifteen to twenty minutes.
If people want to wait forever, they're welcome to. But I think that is
how
the physiology works. And when women remain upright after birth, say
kneeling, the placenta plops out in a very effortless fashion, none of
the
sitting around on buckets for hours that I was brought up with (which I
think is what happens when you miss the vital signs of separation, the
woman
is lying or sitting, and the cervix starts to close...)
And, before I get a mass of abuse, I would just like to say that if I am
your midwife and you have feelings about how you want your third staged
managed, and want to wait for all pulsation to cease, or wait for an
hour,
or wait all day, or anything, I am happy to serve you in that choice.
But
if you're just somebody with no strong feelings about birth, and you
just
want to get your placenta out and get on with your life, and all your
friends had 'the injection,' I'll tell you that in my experience,
placentas
normally come pretty quickly,
From: betsy on
On Jan 17, 3:48 pm, Sarah Vaughan <nanny...(a)samael.demon.co.uk> wrote:
> I posted a brief birth story here right after getting home, but I
> finished writing the full one for my blog a couple of weeks back & just
> remembered that I meant to post the link here for anyone who's
> interested. It's at
> <http://goodenoughmummy.typepad.com/good_enough_mum/2007/12/birth-stor...>.
>
> All the best,
>
> Sarah
> --http://www.goodenoughmummy.typepad.com
>
> "That which can be destroyed by the truth, should be" - P. C. Hodgell

Great birth story, thanks for posting this. My midwife now
automatically includes a birth tub charge in her standard fee. With
my current pregnancy, she said at the beginning that she would delete
the birth tub from the contract and subtract the charge from the
standard fee since my labors are too fast for filling it.

--Betsy